Summary
The Southern Health and Social Care Trust’s anticoagulant team developed
guidelines to promote the safe use of Direct Oral Anticoagulants (DOACs) and assist
clinicians in initiating the medicines. The team identified an opportunity to
change first line treatment for patients presenting with a DVT from warfarin
and a low molecular weight heparin (LMWH) to rivaroxaban. By changing the
treatment, patients would benefit by not having to return to ED for daily
injections until their INR was therapeutic. On implementation, an immediate
drop in the number of ED DVT clinic attendances and a fall in the average
number of patient visits was seen. The anticoagulant team also audited
prescribing practices for patients newly started on DOACs in hospital and
measured the impact that DOAC use had on inpatient stay on the acute stroke
ward.
Challenge
The anticoagulant team decided to offer rivaroxaban as first line
treatment for DVT treatment - DOACs have been shown to be as safe and effective
as warfarin in clinical trials and have several benefits. However, for reasons
of intolerance, fear of warfarin or resistance to routine monitoring, many patients
are either receiving anti-platelets or no anti-thrombotic treatment.
Objectives
To change the first line treatment of DVTs in the ED from warfarin and
LMWH to rivaroxaban, which was approved by NICE in July 2012 for the purpose. To
audit the impact the change had on both patients and the ED, measuring the
number of patient visits to the ED both before and after the change of
treatment, as well as any cost difference. To audit the inpatient and discharge
prescribing practices of the DOACs by the medical staff on all the wards over a
six-month period and the length of hospital stay of patients on the Acute
Stroke Ward - to allow a comparison to be made for patients commenced on
warfarin compared with those on a DOAC. The data would be used in healthcare
staff training sessions and to promote further safe and appropriate use of
DOACs in the Southern Trust.
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